Provider Demographics
NPI:1730395187
Name:MAYHEW, JARROD ASHLEY (OD)
Entity type:Individual
Prefix:
First Name:JARROD
Middle Name:ASHLEY
Last Name:MAYHEW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 HAPPY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-8076
Mailing Address - Country:US
Mailing Address - Phone:270-678-4338
Mailing Address - Fax:270-678-2647
Practice Address - Street 1:2345 HAPPY VALLEY RD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-8076
Practice Address - Country:US
Practice Address - Phone:270-678-4338
Practice Address - Fax:270-678-2647
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1461DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77000495Medicaid
9368201Medicare PIN
KYU87079Medicare UPIN